May 08, 2013 8:00 AM

Author: Melinda Rogers

After her second child was born, Lisa Clift’s world slowly started unraveling with an embarrassing medical problem that stemmed from an episiotomy: She could no longer control her bowels.

Unbeknownst to her, the 43-year-old Park City teacher’s anal sphincter muscles had been permanently torn during the childbirth process with her oldest son, leaving her unable to control when and where she went to the bathroom.

It often left Clift in humiliating situations and forced the mother of two to wear protective pads and carry around an extra change of clothes. The condition also eroded Clift’s confidence to be out in public.

She missed out on activities with her husband and children that were once routine for fear that she wouldn’t be able to find a restroom. She stopped swimming with her kids. She skipped boating trips that were once the highlight of the family’s summer. She worried about working with students in class each day.

“Every time we went out in public it would be like, ‘Oh my gosh, where is the restroom? I need to know,’ said Clift. “I was absolutely mortified. It scared me to do anything. It got to the point where I would just stay at home while my husband took the children places. They’d come home and I’d say, ‘Did you have fun?’ And they’d say ‘Yeah, but we missed you.’”

Clift lived with the condition for years, searching unsuccessfully for answers through visiting a series of gynecologists who struggled to provide a diagnosis for why she couldn’t control her bowels. Many simply told her that the condition was just something she’d need to live with as a result of having children. In 2005, she even underwent a hysterectomy; hopeful for an end to leakage problems after one doctor told her removing her uterus might bring an end to her condition.

When the hysterectomy didn’t work to stop her incontinence issues, Clift kept searching for a diagnosis that might explain why her body was acting the way it was.

The string of doctors Clift visited over the years at last yielded recommendation to one at the University of Utah who would change her life: Sarah Vogler, MD, an assistant professor of Colon and Rectal Surgery in the Department of Surgery at the University of Utah School of Medicine and Huntsman Cancer Center.

Clift was unsure whether her appointment with Dr. Vogler would bring any change after years of frustration with other doctors. Her appointment with Dr. Vogler, however, would prove to be life-changing. Vogler offered Clift a diagnosis for the root of her fecal incontinence.

“Your rectum is supposed to have an “O ring” of sphincter muscles around it. Your muscles look like a “U ring” because these muscles have been torn from having babies and that does not heal,” Clift recalled Vogler explaining. “I was like ‘What? You’re kidding me.’ For so long, no one could tell me what was wrong. And finally someone said, ‘Well this is your problem.’ I was dumbfounded.”

Besides finally receiving a diagnosis, Clift was also given the opportunity for a new treatment that offered hope for ending her humiliating condition.

In 2011, the FDA approved a new technology for the treatment of fecal incontinence –a condition that in addition to Clift, affects more than 18 million women in the U.S. Sacral Nerve Stimulation (SNS) –is a minimally invasive treatment option, which helps patients regain complete bowel control. The University of Utah is the first hospital in the Intermountain West to offer the procedure.

SNS is like a cardiac pacemaker for the anal sphincter, said Vogler, who has treated several patients like Clift in recent months.

The procedure involves surgeons first implanting what’s called a “temporary subcutaneous stimulator” near the sacral nerves. The device influences the behavior and enhances the sensation of the anal sphincters, pelvic floor muscles and bowel, which in turn alerts patients as to when they need to go to the bathroom.

Later, surgeons implant a permanent stimulator in a second procedure for patients who experience improvement of more than 50 percent in the number of bowel incontinence episodes they experience during a two-week trial, Vogler said. Both procedures require patients to undergo only local anesthesia and intravenous sedation and do not have a long recovery period.

Initial national studies show that more than 80 percent of patients achieve greater than a 50 percent reduction in incontinent episodes per week, Vogler said.

Clift is one of those patients. She underwent surgery in January and credits the procedure for helping her to regain her life. She now attends functions for her kids, the youngest who is now 12, worry-free. Intimacy with her husband has improved. And she feels more successful at work.

“I feel more confident in front of the classroom because I’m not always worrying about, ‘Oh my gosh, I’m [going to have an accident]. ‘How am I going to talk to my students?’ Clift said.

Clift said she has become more open about talking about her condition, which admittedly isn’t always a comfortable topic to share with friends. Since opening up, Clift said several women have connected with her to say that they, too, have experienced fecal incontinence.

In fact more than 18 million women in the U.S. suffer from the condition, according to the National Digestive Diseases Information Clearinghouse.

Fecal incontinence occurs when rectal and anal muscles and nerves are damaged, most commonly through complications during childbirth, inflammatory bowel disease, irritable bowel syndrome, pelvic surgery, neurological disorders, nerve or muscle damage, spinal trauma and radiation therapy in the pelvic area to treat cancer.

The condition strikes in a full range of degrees, from the leakage of small amounts of fecal matter when passing gas, to complete loss of bowel and rectal control, said Vogler.

While the NDDIC doesn’t tally state by state statistics for the number of fecal incontinence cases reported, it’s possible Utah could have a higher number of cases than the rest of the country because of Utah’s high birth rate.

Utah in 2011 reported the highest birth rate in the U.S. with 18.2 live births per 1,000 Utahns or 51,144 total live births overall, according to Utah Department of Health statistics.

Clift said she wishes discussion of fecal incontinence – a topic that can elicit snickers from those who might not understand how life-altering it can be –becomes more commonplace so women suffering from it can find out more about resources available to them.

“I’ve told practically everybody I know, ‘I had a pacemaker put in my butt. Everyone just laughs,’” said Clift. “ ‘I said no, seriously, I’m having rectal dysfunction. Now, I have numerous women asking me about it, and I tell them all about Sarah.’”

For Dr. Vogler, hearing success stories like Clift’s is rewarding. In the last six months, 100 percent of patients that Vogler has treated with SNS have gone on to have the second-stage of the procedure.

“I get more positive comments about SNS than about any other treatment offered for fecal incontinence at the University of Utah,” Vogler said. “Very grateful patients tell me, ‘SNS has given me and my family our lives back. I no longer need to stay home near a bathroom.’” “In my practice, I have found SNS is easier, safer and achieves better results than any of the other options to treat fecal incontinence,” she said.

Melinda Rogers

Melinda Rogers is a Communications Specialist at the University of Utah Health Science Public Affairs Office.

incontinence urogynecology

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